How does FLACS work?

1. Measurements of eyes – The laser system captures detailed, 3D images of the eye to plan the incisions pattern prior to surgery.
2. Laser Application – The femtosecond laser creates tiny, precise incisions in the cornea and performs a circular capsulotomy on the lens capsule. It also fragments the cataract.
3. Lens Removal – The surgeon removes the pre-cut disc from the capsule's front side in the operating room. The small fragments are subsequently divided up into smaller pieces via ultrasound energy (phacoemulsification). It is removed via a vacuum suction.
4. Lens Implantation – An artificial intraocular lens (IOL) is inserted to help the patient regain vision.
5. Recovery – Most patients notice visual improvement within a few days, with complete recovery in a few weeks.

FLACS vs Conventional Cataract Surgery

During conventional cataract surgery, these steps are executed manually by the surgeon with precise tools. This technique has been refined throughout the years and still remains the most commonly utilised method worldwide. It is known for achieving good visual outcomes and has excellent safety records.

FLACS assists the surgeon by using the laser to carry out some of these steps. It adds precision and may reduce the amount of ultrasound energy used during cataract surgery.

The overall visual results between FLACS and conventional surgery are comparable when performed by an experienced surgeon. The experience and skill of the surgeon remain the most important factors that influence surgical results.

Risks and Considerations

As with any surgical procedure, FLACS carries some potential risks, such as:

• Discomfort after surgery
• Redness after surgery
• Fluctuation of vision during recovery
• Swelling of cornea or retina (rare)
• Infection (rare)
• Higher cost

While FLACS provides more accuracy, the visual outcome is highly dependent on IOL choice, corneal health, and cataract severity.

Who is Suitable for FLACS?

FLACS may be especially suitable for:

• Mature / white intumescent cataracts
• Zonular weakness
• Patients considering astigmatism-correction (toric) or multifocal lens implants
• Patients who prefer a technologically-assisted procedure
• Eyes that have specific needs anatomically, where precision is required

Patients with corneal scarring or certain eye conditions may not be good candidates. An eye examination by an ophthalmologist is essential in determining if FLACS is beneficial.

Cost of FLACS in Singapore

FLACS has a higher fee compared to conventional cataract surgery as it utilizes laser technology and equipment. Fees in Singapore could vary from S$2,000 to S$3,000 for each eye, additionally. Patients are recommended to check eligibility for insurance or Medisave claims before proceeding. For the costs of conventional cataract surgery in Singapore, you can read it here.

Summary

Conventional cataract surgery remains as gold standard as it is trusted by surgeons worldwide for its consistency in producing excellent results. FLACS represents an advancement in cataract surgery by merging laser precision with the established effectiveness of conventional phacoemulsification.

Patients should consult with an ophthalmologist to determine which option best matches their eyes and visual objectives.

It is a refractive error where the light entering the eye is focused in front of the retina instead of directly on it.

Myopia affects a significant portion of the global population, with estimations suggesting that by 2050, approximately 4758 million people will be affected (around 49.8% of the world population) (Holden BA, et al., 2016).

Singapore has one of the highest rates of myopia in the world. By Primary 6, 65 percent of our children are myopic, and this figure rises to 83 percent in young adults. Recently, it has also been reported that there are increasing cases of high myopia in adults in Singapore.

This has led to Singapore being dubbed the “Myopia Capital of the World.” Projections for 2050 suggest that 80 to 90 percent of all Singaporean adults over 18 will be myopic, with 15 to 25 percent potentially experiencing high myopia.

Causes of Short-Sightedness (Myopia)

Myopia, or nearsightedness, is caused by a combination of environmental and genetic factors. Urbanized lifestyles that involve intensive near work, such as reading and using digital devices, contribute significantly to the development of myopia. Additionally, limited outdoor activities can exacerbate this condition.

Genetic factors also play a crucial role. Children born to myopic parents are at a higher risk of developing myopia themselves.

Symptoms of Short-Sightedness (Myopia)

Common symptoms of myopia include:

• Blurred vision at a distance
• Squinting
• Eye rubbing
• Headaches
• Eye fatigue
• A tendency to hold reading materials closer

If you have severe short-sightedness, you may be at greater risk for other eye-related issues, such as:

• Stretching and thinning of the retina (the back of the eye).
• Retinal holes and tears.
• Retinal detachment: The retina separates from the underlying blood vessel layer, which can lead to blindness if untreated.

Diagnosis of Myopia

In an optometry practice, a comprehensive eye examination for myopia includes reviewing the patient’s history, current symptoms, and family ocular history.

Refraction would be carried out with instruments such as a phoropter and retinoscope to confirm the presence of myopia.

The degree of myopia is measured in negative dioptre (D) values, such as -1.00D,

-2.50D, or -6.00D, reflecting the power of the lens required to achieve optimal vision.

A higher negative dioptre value indicates greater myopia severity.

Treatment for Short-Sightedness (Myopia) in Singapore

Although a cure for short-sightedness has yet to be found, there are several ways to improve vision for individuals with this condition.

Methods to correct vision for short-sightedness include:

• Wearing glasses: A straightforward and safe way to enhance vision.
• Wearing contact lenses: These are placed directly on the eye. Types of contact lenses include soft daily lenses, extended-wear lenses, and rigid gas-permeable contact lenses.
• Laser vision correction surgery: Laser vision correction surgeries are available for those seeking more long-lasting myopia correction, such as laser PRK, LASIK, SMILE and ICL implantation.
• Orthokeratology: Often referred to as Ortho-K, is another option. It involves wearing specially designed rigid contact lenses overnight, which temporarily reshape the cornea. This corrects myopia so that you can see clearly during the day without needing glasses or contact lenses. The effects are reversible but can be maintained by continuing to wear the lenses regularly at night.
• Intraocular lens surgery: This involves replacing the natural lens with a small plastic lens (intraocular lens).

Preventative Strategies

Increasing time spent outdoors has been associated with reduced risk of myopia progression. Research suggests that increased exposure to natural light and balance between indoor and outdoor activities correlates with a reduced risk of myopia advancement.

Effectively managing the amount of time for near tasks such as reading and screen time could help to manage the progression of myopia. Implement regular breaks following the 20-20-20 rule: every 20 minutes, take a 20-second break and look at something 20 feet away can alleviate visual strain and reduce risks of near work-induced myopia.

Low-dose atropine eye drops have been found to slow myopia progression in children, although they do not correct the existing myopic refractive error.

Complications of Myopia

Myopia occurs when the eyeball is too long or the cornea is too curved. Complications can arise due to the elongation of the eyeball, such as retinal detachment, glaucoma and myopic maculopathy.

Regular eye exams are therefore essential for individuals with myopia to monitor any changes in their vision and to detect and manage any complications at early stages.

Conclusion

Individuals with myopia need to undergo regular eye examinations and follow appropriate management and treatment recommendations from an eye care professional to monitor for potential complications and preserve vision health.

Early detection and intervention can help reduce the risk of vision impairment or blindness associated with myopia-related conditions.

FAQs

1. Is astigmatism the same as short-sightedness?
   1. Although myopia and astigmatism can commonly coexist in individuals, these are two different eye conditions after all. Astigmatism affects both far and near vision, causing blurring, distortion, and overlapping images in vision.
2. Are contact lenses safe for children?
   1. Contact lenses are safe for children as long as they are compliant with lens care hygiene and instructions. Contact lens fitting with an optometrist is vital to ensure optimal lens fitting and the best lens choice is chosen based on the lifestyle.
3. How much does LASIK surgery cost?
   1. Depending on the type of laser refractive surgery, the surgery cost in Singapore typically ranges around $3000-$6000. Find out more here.
4. How can I tell if my child is developing myopia?
   1. Possible symptoms of children developing myopia include a tendency to hold reading materials closer, squinting when looking at far objects, reduced performance at school, eye rubbing, and complaints of headaches.
5. Can myopia lead to blindness?
   1. While myopia itself typically does not lead directly to blindness, it can increase the risk of certain eye conditions, such as glaucoma and retinal detachment, that may cause blindness if left untreated.
6. Can a short-sighted person be a pilot?
   1. Individuals with myopia may become pilots, but there are certain requirements and considerations they must meet for flying depending on different country aviation authorities.

Throughout history, people have experimented with various methods to improve their vision such as using polished gems or glass. The idea of using contact lenses for vision correction took a significant leap forward in the 14th century with the invention of spectacles.

These spectacles were not just functional but were a symbol of wealth and status.

Leonardo da Vinci then came up with the idea of contact lenses in the 16th century but only became a reality in the late 19th and early 20th centuries with advancements in materials. Contact lenses were initially made from glass and later from a plastic called PMMA.

A new material called Silicone Hydrogel introduced in the late 20th century has become the standard for modern contact lenses as it makes contact lens use more comfortable and healthier for users.

Types of Contact Lenses

• Soft contact lenses, primarily composed of silicone hydrogel, offer excellent oxygen permeability. They are available in various modalities, including daily disposables, bi-weekly, and monthly disposables. Daily disposables are worn once and discarded for hygiene and convenience. Bi-weekly and monthly lenses are replaced accordingly and require regular cleaning and maintenance.
• Rigid Gas Permeable (RGP) Contact Lenses are made of hard plastic with good oxygen permeability. They offer excellent vision correction, especially for specific issues soft lenses may not address. However, they require a longer adaptation period and more maintenance. The choice between these two types depends on individual preferences, lifestyles, and vision needs.

Contact lenses also come in various designs including toric correction for people who require their astigmatism corrected and multifocal designs for people with presbyopia.

Pros of Contact Lenses

Contact lenses offer several advantages.

They provide enhanced vision quality compared to glasses, offering a wider field of view and reducing distortions, particularly in peripheral vision for a higher prescription.

Their compatibility with an active lifestyle makes them ideal for sports and physical activities, providing freedom of movement without the constraints of glasses.

Furthermore, contact lenses come in various colors and designs for aesthetic purposes. Beyond aesthetics, contact lenses can boost confidence by providing vision correction without visible eyewear, improving self-image and overall quality of life.

Cons of Contact Lenses

While contact lenses offer numerous benefits, they also come with several considerations.

One of the main considerations is the need for consistent maintenance and hygiene practices. Users must be compliant with daily care routines and hygiene practices to prevent infections, which can arise from poor lens care.

Additionally, users tend to wear their contact lenses for a prolonged period which can give rise to discomfort and dryness.

The risk of eye infections and complications can vary from inflammation of the inner surface of the eyelid to more severe conditions that require constant medical attention and in rare cases corneal transplant.

Regular check-ups with an eye care professional are essential to monitor eye health and promptly address any potential problems.

Risks Associated with Contact Lenses

Contact lenses can pose risks of infection and microbial contamination if not handled properly. Microbes such as bacteria and fungi can accumulate on the lenses and cause infections if they come into contact with the eyes.

To minimize these risks, it’s crucial to maintain proper hygiene practices, including:

• Washing hands thoroughly before handling lenses
• Regular cleaning and disinfection of lenses
• Replacing them as recommended.

Avoid sleeping in lenses and limiting water exposure while wearing lenses can also help reduce the risk of microbial contamination.

Allergic reactions can be a concern for contact lens wearers, with common allergens including components of lens solutions and debris that can accumulate on the lenses. Managing allergies while using contact lenses may involve switching to preservative-free solutions or using daily disposable lenses to reduce the risk of irritation.

Additionally, practicing good hygiene, such as washing hands before handling lenses and cleaning lenses regularly, can help minimize allergen exposure.

If allergies persist or worsen, consulting an eye care professional is recommended to explore alternative solutions.

Costs of Contact Lenses

Contact lenses can come with various costs that wearers should consider.

Initial costs include the price of the lenses themselves, which can vary depending on the type and brand of lenses. There may also be additional costs for an eye exam and fitting.

Ongoing costs include the cost of cleaning and disinfecting solutions, as well as replacements if the lenses are not daily disposables. These costs can add up over time and should be factored into the decision to wear contact lenses.

Alternatives to Contact Lenses

There are several alternatives to contact lenses, including eyeglasses and refractive surgery such as PRK, LASIK, ReLEx Smile, and ICL.

Eyeglasses offer advantages such as convenience, as they require minimal maintenance compared to contact lenses. They also provide protection against environmental factors such as dust and allergens.

Laser refractive surgery is a surgical procedure that reshapes the cornea to correct vision. Another option is implantable contact lenses (ICLs), which are surgically implanted lenses that can correct vision without the need to reshape the cornea.

However, not everyone is eligible for refractive surgery as factors such as age, eye health, and prescription stability need to be considered.

Each of these alternatives has its own benefits and considerations and it is important to discuss all options with an eye care professional to determine the most suitable choice.

FAQs

1. Can anyone wear contact lenses?
   1. Yes! Most people can wear contact lenses. However, factors such as eye health, the presence of certain eye conditions and lifestyle preferences can influence whether contact lenses are suitable for an individual.
2. How long can I wear contact lenses in a day?
   1. Recommended wearing time will be about 6 to 8 hours a day, a maximum of 5 days a week.
3. Are there age restrictions for using contact lenses?
   1. There are no age restrictions for wearing contact lenses. People of all ages, including children and older adults can wear them. However, fitting a child with lenses should be done under professional guidance with consideration of the child’s maturity level and ability to handle contact lenses responsibly.
4. Can I sleep with my contact lenses on?
   1. It is not recommended to sleep with your contact lenses as they increase the risk of eye infections and other complications.
5. How often should I replace my contact lenses?
   1. The frequency of replacement depends on the type of contact lenses you are wearing. Daily disposable contact lenses are to be discarded after each use. For bi-weekly or monthly contact lenses, they should be replaced accordingly as the term suggests.
6. Are colored contact lenses safe for my eyes?
   1. Colored contact lenses are safe for your eyes if you get them from a reliable source using a valid prescription and with an appropriate duration of use.
7. Can I swim or shower with contact lenses?
   1. It is not recommended to swim or shower while wearing contact lenses. Exposing your contact lenses to water can increase the risk of microbial infection.
8. What should I do if I experience discomfort with my contact lenses?
   1. Remove your contact lenses immediately and seek medical attention.
9. How do I clean and care for my contact lenses?
   1. Handle the contact lenses with clean hands.
   2. For biweeklies and monthlies, rub the lenses on the palm of your hand for 20 seconds with a few drops of contact lens solution to remove any debris.
   3. Rinse the lenses thoroughly with the contact lens solution and store them with fresh contact lens solution before the next use.
   4. Replace your contact lenses promptly based on their replacement schedule.
   5. Replace your contact lens case every 3 months, or immediately if it is damaged.
10. Is LASIK a permanent solution for vision correction?
    1. LASIK can provide long-lasting vision correction by reshaping the cornea. However, it may not be permanent for everyone. Factors like age and eye health can impact results. Consulting with an eye care professional is key to understanding if LASIK is suitable for you.

Making an Informed Decision

Consulting an eye doctor is the first step in making an informed decision about vision correction.

They will evaluate your vision and eye health, and discuss your lifestyle and visual goals. Information about the risks, benefits, and potential costs associated with options suited for you will be shared, helping you make a decision tailored to your individual needs.

Conclusion

In conclusion, the journey of vision correction has evolved from ancient practices to modern innovations like contact lenses and refractive surgery.

Individuals now have a range of options to correct their vision, each with its advantages and considerations.

Making informed decisions about vision correction involves understanding these options, consulting an eye care professional, and considering individual lifestyles and preferences. Regular eye checkups and professional guidance are crucial for maintaining eye health and ensuring the best outcomes.

By staying informed and proactive, individuals can make choices that support their eye health and enhance their quality of life.

Astigmatism is a common refractive error of the eye, akin to myopia (near-sightedness) or hyperopia (longsightedness).

Astigmatism occurs when the cornea or lens of the eye has an irregular shape, causing light to focus unevenly on the retina. It can exist alongside myopia or hyperopia, or on its own.

What Causes Astigmatism?

There are two meridians, usually at right angles to each other.

In astigmatism, these meridians have different curvatures, one being steeper and the other being flatter. This uneven curvature causes light to focus on multiple points rather than a single point on the retina, resulting in blurred vision.

Factors that put an individual at a higher risk of developing astigmatism:

• Genetics, where one or both parents have astigmatism
• A corneal scar after an ocular surgery or injury
• Keratoconus, a rare eye condition where the cornea progressively thins and bulges
• Congenital abnormalities or degenerative disorders

Illustration of normal vs. astigmatic corneas

Recognizing the Symptoms of Astigmatism

Due to light rays focusing at different points on the retina in individuals with astigmatism, it will cause images to appear blurred or ‘fuzzy’.

Individuals may also experience other symptoms like eye strain, and headaches due to squinting. It increases difficulty seeing at night or in low-light conditions.

Real-life examples of blurred vision scenarios

• Driving in low-light conditions makes seeing road signs, traffic signals, and other vehicles difficult.
• Fine detail tasks such as reading small print, threading needles, or working on intricate crafts can be challenging.

Diagnosis of Astigmatism

Diagnosing astigmatism involves a comprehensive eye examination conducted by an optometrist or ophthalmologist.

• The patient’s visual acuity (VA) will be assessed, where the eyecare practitioner identifies visual impairments if any.
• Measurement of the refractive error of the eye through the refraction test. The practitioner uses corrective lenses to assess the power of myopia, hyperopia, and/or astigmatism.
• After the patient’s refractive error has been determined, they will be given a prescription. It would typically be written in the format shown below:
  •  SPHERECYLINDERAXISVISUAL ACUITYRight Eye-3.00-0.751806/6

“SPHERE” is the refractive power indicating if the patient is myopic (minus power) or hyperopic (plus power). An individual can only either be myopic, or hyperopic.

“CYLINDER” is the refractive power of astigmatism in the patient, and this is typically corrected by a cylindrical lens.

“AXIS” is the meridian where the steepest curvature of the cornea is.

Corneal topography is a diagnostic imaging technique that is used by practitioners when astigmatism is suspected.

Treatment Options for Astigmatism

#1 Eyeglasses

The most common and simplest treatment for astigmatism. Toric lenses can be customized to correct both spherical and cylindrical components of an individual’s refractive error.

Pros

• With the ability to customize the lenses to an individual’s refractive power, eyeglasses can provide precise and consistent correction for astigmatism.
• Convenient as they can be quickly worn and removed as and when needed.
• Frames comes in a variety of materials, and designs which individuals can choose to suit their personal preferences.
• Physical protection for eyes against environmental hazards like dust, debris, and harmful UV rays.
• Often more affordable with minimal expenses required for maintenance.

Cons

• Increased peripheral distortion in individuals with a higher prescription.
• Individuals may experience the “swimming” effect and find it difficult to adapt to new frames or new refractive powers.
• Inconvenient and impractical for activities where they can be easily displaced or damaged.
• Tend to fog up in cold or hot conditions.

#2 Contact lenses

Toric soft contact lenses (SCL) and rigid gas permeable (RGP) lenses are available in designs that provide clear vision for individuals with irregular corneal shapes. Those with higher power of astigmatism would benefit from a different RGP-material lens known as the “scleral lens.” It provides vision correction and comfort.

Pros

• Provides a clear and natural field of vision.
• Provides an aesthetic advantage for many individuals.
• With the freedom of movement, there are fewer opportunities to displace or damage one’s visual aid.

Cons

• Adaptation period for first-time contact lens users where they may experience discomfort or irritation during wear.
• Increased risks of developing eye infections may arise from improper contact lens care regimens or lack of hygiene practices while handling contact lenses.
• Regular contact lens reviews are required to ensure the contact lenses are well-fitted.
• A high commitment to lens care is required – cleaning, disinfecting, and replacing lenses on a regular schedule.
• Contact lenses and cleaning solutions can be costly.
• Some individuals may have certain pre-existing contraindications, or lifestyle factors that make contact lens wear unsuitable.

#3 Refractive surgery

Refractive surgery offers a permanent solution for correcting refractive errors by reshaping the cornea to improve its curvature and focusing ability. When considering this option, a detailed assessment is required to assess the patient’s suitability.

Types of refractive surgeries:

• Laser-Assisted In Situ Keratomileusis (LASIK) – A thin flap is created on the cornea and a laser is used to reshape the underlying cornea tissue. The flap is then repositioned, and the cornea heals naturally.
• Photorefractive Keratectomy (PRK) – Reshapes the cornea’s surface by removing the epithelial, the outer layer, before the laser treatment, instead of creating a flap like LASIK.
• Small Incision Lenticule Extraction (SMILE) – Creates a small incision in the cornea to remove a small piece of tissue, known as lenticule, to reshape the cornea to correct for refractive error.
• Implantable Collamer Lenses (ICL) – Permanent contact lenses placed inside the eye to correct for refractive error. The procedure is reversible and corrects a wide range of prescriptions.

Lifestyle Tips for Managing Astigmatism

• Ensure glasses are correctly prescribed.
• Ensure proper lighting when reading or performing close-up tasks to minimizes eyestrain.
• Avoid rubbing the eyes

FAQs

1. Question: Can astigmatism be inherited?
   1. Answer: Yes. Astigmatism has a genetic component and can run in families.
2. Question: How often should I get my eyes checked for astigmatism?
   1. Answer: An eye check once every two years is sufficient if an individual is well.
3. Question: Are there natural remedies to improve astigmatism?
   1. Answer: There are no scientifically proven natural remedies to cure or reverse astigmatism.
4. Question: Can astigmatism get worse over time?
   1. Answer: Yes, astigmatism can worsen over time for some individuals.
5. Question: What are the risks associated with refractive surgery for astigmatism?
   1. Answer:
      1. Undercorrection or Overcorrection. Undercorrection may require enhancement procedures to improve vision, while overcorrection may necessitate corrective lenses or additional surgical interventions.
      2. Induced Astigmatism after surgery
      3. Glare, Halos, and Starburst
      4. Corneal Ectasia
6. Question: Is astigmatism only corrected with glasses or contacts?
   1. Answer: No, astigmatism can be corrected through refractive surgery as well.
7. Question: Can children develop astigmatism?
   1. Answer: Yes, children can develop astigmatism. Astigmatism can occur at any age, including infancy and childhood.
8. Question: Are there specific foods that can improve astigmatism?
   1. Answer: There is no direct evidence to suggest that specific foods can improve astigmatism.

In Singapore, according to National University Hospital (1997), the percentage of elderly patients affected by cataracts is about 78.6%. Cataract cases in Singapore increased by 37% in the last 10 years, according to research from the Singapore National Eye Centre (2013). The number of people affected by cataracts also increases as they get older. It affects 63.6% of people between 60 and 64 years, and 94.6% of people 75 years and older.

Between 1991 and 1996, an average rate of 356.4 cataract operations per 100 000 persons per year were performed on Singapore residents, (95% confidence interval [CI], 353.6-359.2). The average rate was highest for Indians (age-sex adjusted rate of 396.5 per 100 000/year), followed by Chinese (371.2 per 100 000/year), and lowest for Malays (237.2 per 100 000/year).

Interestingly, women were observed to have 14% higher rates of cataract surgery than men of the same age group, with this pattern consistent across the 3 racial groups in this study (Wong, 2001).

Cataract surgery in numbers

Cataract surgery is the most prevalent surgical procedure of all medical specialties and is performed over 28 million times around the world every year. Globally, there are nearly 60,000 cataract procedures every day. Based on the data report from the Royal College of Ophthalmologists in 2022, with an aging population and increasing cataract prevalence, it is estimated there will have been a 50% rise in cataract procedures between 2015-2035.

Modern cataract surgery is a common, safe, and effective procedure. More than 30,000 cataract operations are carried out annually in Singapore (Poon, 2013). Cataract surgery has a high success rate in restoring vision too. Based on the data from Singapore National Eye Centre in 2019, 99% of all cataract patients achieved the best corrected visual acuity of 6/12 or better after surgery.

Types of cataract procedures

1. Phacoemulsification: This is the most common and widely performed procedure for cataract removal. It involves making a small incision in the eye, breaking up the cataract using ultrasound energy, and removing it through suction. An artificial intraocular lens (IOL) is then implanted to replace the natural lens.
2. Femtosecond Laser-Assisted Cataract Surgery: This advanced technique uses a femtosecond laser instead of a surgical blade to create precise incisions and soften the cataract for ease of removal.
3. Extracapsular Cataract Surgery (ECCE): This technique is similar to phacoemulsification but involves a larger incision and the removal of the cataract in one piece. This is often used in cases where phacoemulsification may not be suitable, such as in advanced cataracts or resource-limited settings.

Risk factors of cataract

• Age: The natural aging process of the crystalline lens in the eye leads to cataracts.
• Exposure to Ultraviolet (UV) Radiation: Prolonged and unprotected exposure to sunlight can increase the risk of cataracts.
• Diabetes: Individuals with diabetes are at a higher risk of developing cataracts. The high blood sugar levels can cause changes in the lens that contribute to cataract formation.
• Medical Conditions: Certain medical conditions such as hypertension, obesity, and prolonged exposure to ionizing radiation, have been associated with an increased risk of cataracts.
• Smoking: The harmful chemicals in tobacco smoke can accumulate in the crystalline lens and lead to oxidative stress, which can contribute to cataract development.
• Previous Eye Injury or Surgery: Having had an eye injury or previous eye surgery, such as surgery for retinal detachment, may increase the risk of developing cataracts.
• Certain Medications: Long-term use of certain medications, such as corticosteroids, may increase the risk of cataracts. These medications can affect the metabolism of the crystalline lens and lead to cataract formation.

Impact of cataracts

• Vision Impairment: Cataracts cause clouding of the lens, leading to blurry, hazy, or decreased vision. This can interfere with daily activities such as reading, driving, recognizing faces, and performing tasks that require clear vision. As cataracts progress, vision loss can become more severe, potentially leading to blindness if left untreated.
• Reduced Quality of Life: Cataracts can significantly reduce an individual's quality of life. Visual impairment can limit independence and participation in social, occupational, and recreational activities. It can also impact mental well-being, causing frustration, anxiety, and depression due to the loss of visual function.
• Economic Costs: Cataracts impose economic costs including expenses related to diagnosis, treatment, and management of cataracts, such as eye examinations, surgical procedures, medications, and post-operative care. Additionally, individuals with cataracts may experience reduced work productivity or early retirement due to vision impairment, resulting in income loss for themselves and their families.
• Burden on Healthcare Systems: Cataracts represent a substantial burden on healthcare systems. The prevalence of cataracts in aging population increases the demand for cataract surgeries. This places a strain on healthcare resources, including surgical facilities, specialized equipment, healthcare professionals, and post-operative care. Healthcare systems need to allocate sufficient resources to address the growing demand for cataract treatment.

Reference list

1. Celojevic, D. & Zetterberg, M. (2015). Gender and Cataract – the Role of Estrogen. Current Eye
   Research 40 (2).
2. SINGVISION Issue 1/2021. All About Cataracts.
3. Wong, T.Y. (2001). Arch Ophthalmol. 2001;119(5):727-732. doi:10.1001/archopht.119.5.727.
4. Zetterberg, M. (2016). Age-related Eye Disease and Gender. Maturitas 83.
5. Yu-Chi L, Mark W, Terry K, et al. Cataracts. Lancet. 2017;390:600-12. Retrieved from: https://doi.org/10.1016/S0140-6736(17)30544-5.
6. Moncef K, Rim K, Rupert B, et al. Number of people blind or visually impaired by cataract worldwide and in world regions, 1990 to 2010. Invest Ophthalmol Vis Sci. 2015;56:6762–9. Retrieved from: https://doi.org/10.1167/iovs.15-17201.
7. Poon Chian Hui. (2013). New Cataract Surgery Cuts Blindness Risk. Retrieved from: https://www.straitstimes.com/singapore/new-cataract-surgery-cuts-blindness-risk

No, wearing prescription glasses does not make your vision worse. In fact, prescription glasses are specifically designed to correct your vision and help you see more clearly. However, wearing glasses may make your eyes feel dependent on them for clear vision.

Without glasses, your vision may appear blurry because your eyes have become accustomed to the correction provided by the lenses. This does not mean that your vision has worsened, but rather that you have become used to seeing clearly with the assistance of glasses.

Not wearing my glasses improves my vision

No, avoiding wearing your glasses does not strengthen your vision. This is a common misconception. If you choose not to wear your glasses when they are prescribed, your eyes will strain to focus, which can lead to eye fatigue, headaches, and discomfort. Over time, neglecting to wear your glasses can even contribute to worsening vision or additional eye problems.

How does aging affect my vision?

As we hit around the age of 40’s, presbyopia develops. It is a natural age-related condition affecting the eye’s ability to focus on close objects. The crystalline lens in the eye loses flexibility as we age, making it difficult to focus on nearby objects, such as reading a book. Presbyopia is typically corrected with reading glasses, bifocals, or progressive lenses.

Cataract is another common condition related to aging, where the crystalline lens in the eyes thicken and become progressively cloudy. This leads to a gradual reduction in the clarity of one’s vision, particularly in low-light conditions. When people develop cataract, they’ll typically have to go for cataract surgery.

Do family genetics affect my eye health?

Yes, family genetics can have an impact on eye health. Many eye conditions and diseases have a hereditary component, including refractive errors (myopia, hyperopia, and astigmatism), glaucoma, Age-related Macular Degeneration (AMD), and color deficiency.

Eating carrots improves my vision

No, carrots are indeed rich in Vitamin A, which is beneficial for eye health. However, it is important to note that eating carrots alone will not improve vision or cure existing eye conditions. In fact, a well-rounded diet, rich in a variety of fruits and vegetables, is more beneficial for eye health.

Vitamins A, C, and E can improve eye health and vision

Vitamins A, C, and E play important roles in maintaining eye health and supporting optimal vision. Other nutrients for eye health include omega-3 fatty acid is essential in overall eye health too.

However, it is worth mentioning that maintaining good eye health goes beyond just diet. Regular eye examinations, wearing prescribed corrective lenses (if needed), protecting your eyes from UV radiation and excessive screen time, and practicing good eye hygiene are all important factors in maintaining and optimizing vision.

Does squinting in the sun damage my eyes?

Squinting in the sun itself does not cause damage to the eyes. In fact, squinting is a natural response to bright light and serves to reduce the amount of light entering the eyes. However, it does not provide comprehensive protection against UV rays. Harmful UV rays from the sun can lead to cataracts and AMD.

Therefore, it is important to wear sunglasses with UV protection to limit UV exposure. Tips such as seeking shade and wearing a wide-brimmed hat outdoors help to reduce UV exposure too.

Does reading in dim light damage my eyes?

Reading in dim light does not cause permanent damage to the eyes but it can give you temporary discomfort and eye strain. Dim lighting decreases the contrast between the text and the background, making it more difficult to read comfortably. As a result, the eyes may have to strain and squint to make out the words, which can contribute to eyestrain and decreased reading efficiency.

Does sitting too close to the TV harm my vision?

No, sitting too close to the TV does not harm your vision. However, sitting close to the TV screen may cause eye strain and headaches as your eyes may need to work harder to focus on the images.

Only older people get cataracts, glaucoma and age-related macular degeneration

The belief that only older people get cataracts, glaucoma and age-related macular degeneration is a myth. While it is true that these conditions are more prevalent in older individuals, they can occur at any age due to various factors, including in children and young adults.

There is nothing you can do to prevent or slow down cataracts, glaucoma and age-related macular degeneration

The truth is, there are a few strategies we can do to slow down these diseases. Maintaining a healthy diet and practicing a good lifestyle can minimize the risks of all these ocular diseases. Routine eye examinations are crucial for early detection and management of these conditions. Regular follow-ups allow your eye doctor (ophthalmologist) to monitor any changes and provide appropriate interventions to slow down the progression.

Wearing UV protection such as sunglasses or using an umbrella can also help to slow down cataract progression.

I don’t need an eye exam unless I’m having problems

Regular eye examinations are crucial for early detection of eye conditions. Many eye conditions, including glaucoma, age-related macular degeneration (AMD), diabetic retinopathy and cataracts do not present noticeable symptoms in their early stages.

By the time symptoms become apparent, irreversible damage to your eyesight may have occurred. Regular eye exams enable eye care professionals to detect these conditions at their earliest stages when they are more treatable and manageable.

Here are some tips to maintain good eye health:

1. Regular eye examinations: Routine eye checks help detect and manage eye diseases more
   effectively.
2. Protect your eyes from UV rays: Wear sunglasses that provide 100% UV protection whenever
   you are exposed to sunlight.
3. Follow a balanced diet: Eat a nutritious diet rich in fruits, vegetables, and foods high in omega-3
   fatty acids (such as fish) to support good eye health. Foods like leafy greens, carrots, citrus fruits,
   and nuts contain vitamins and antioxidants that promote healthy eyes.
4. Follow the 20-20-20 rule: Every 20 minutes, look away from the screen and focus on an object
   20 feet away for at least 20 seconds.
5. Avoid smoking: Smoking has been linked to an increased risk of eye conditions, including
   cataracts, glaucoma, and AMD.
6. Maintaining a healthy lifestyle: Exercising regularly, maintaining a healthy weight, managing
   systemic conditions like diabetes and hypertension, and getting enough sleep will all contribute
   to good eye health.
7. For contact lens wearers, ensure not to overwear your lenses, clean and store your lenses
   correctly, replace them as recommended, and avoid sleeping or swimming with contact lenses.
8. Practice good hygiene: Wash your hands thoroughly before touching your eyes or apply any eye
   drops or contact lenses to reduce the risk of eye infections.

During the CB, the public was advised to stay home as much as possible and only leave home for essential services which included purchasing of food or seeing the doctor if unwell. Most workplaces were also closed except for those providing essential services (eg food, transportation, health and social services, haircuts). Most of the working population had to work from home while schools moved to home-based learning.

While private acute hospitals (including eye specialist clinics) were allowed to remain open for essential services, they were only allowed to take in appointments that were urgent and required immediate medical attention. All non-essential and non-urgent appointments were to be deferred.

As Singapore entered Phase 2 of post-CB, specialist medical clinics resumed seeing all types of medical appointments. At the same time, the government has deemed it safe for the public to resume activities outside of their homes. Safety measures were in place though, with gathering in groups of no more than 5 people. It is also mandatory to wear a mask in public.

At Atlas Eye Specialist Centre, we have also resumed seeing patients in Phase 3 including those who required cataract surgery as well as elective surgeries such as LASIK. Following the guidelines set out by the Ministry of Health, we ensure that all who entered our premises go through a triage. Those who are unwell or have been out of the country 14 days prior to their appointment will be denied entry. Social distancing measures have been implemented including:

• Placing ‘keep 1 metre apart’ signages on the seats at the waiting area
• Allowing only 1 companion if a patient has special needs (eg younger than 21 years old, elderly)

Rest assured that your safety is our priority. If you would like to come in for an eye check, please contact us at +65 6737 9119 or atlaseye@atlaseye.sg.

There are several causes; the most common is due to diabetes and the use of corticosteroid medication. Other risk factors include ageing, smoking, obesity, high blood pressure, previous eye inflammation, injury or eye surgery.

Symptoms

Akin to other types of cataract, symptoms of PSC include blurring and cloudiness of vision, reduced contrast sensitivity, difficulty reading especially in low light and seeing more glares and haloes.

When PSC progresses to an advanced stage, the vision becomes poor resulting in people getting into accidents as they are unable to see well.

More importantly, it may lead to another condition known as glaucoma and in particular, angle closure glaucoma, a condition where the pressure in the eye builds up and presses onto the optic nerves at the back of the eye.

Glaucoma can cause irreversible vision loss. Symptoms include red eye, pain, nausea, and vomiting.

At this stage, the risk and complexity of the surgery increase as it becomes more difficult to remove a very dense cataract.

Types of cataract surgery

At Atlas Eye Specialist Centre, we provide 2 types of cataract surgery:

1. Micro-incision phacoemulsification 

This uses ultrasound energy to emulsify and break apart the cataract for it to be removed through a small 2 to 3mm incision. An intraocular lens will thereafter be implanted. No suture is needed as the wound heals on its own. This provides more comfort and a faster recovery post-surgery. 

2. Laser-assisted cataract surgery 

This uses the femtosecond laser used in LASIK surgery to create the 2 to 3mm incision. Ideal for complex surgeries, this method is also seen as being minimally invasive, has improved wound construction, and allows for accurate lens positioning.

However, the procedure costs more than micro-incision phacoemulsification surgery and its benefits are not seen as significant enough to warrant the price difference.

Cataract surgery is a 30-minutes day surgery (1 eye) performed in the hospital. Two eyes are performed on separate days to reduce the risk of infection (to leave at least 1 day apart between 2 eyes).

For Singaporeans, we can claim Medisave up to $2,450 per eye. The surgery is also insurance claimable, depending on the coverage.

For a cataract assessment, please contact us +65 6737 9119 or atlaseye@atlaseye.sg.